What are 5 maternal reasons for a C/S birth?
1. Pre-existing conditions- DM, heart disease
2. Active genital herpes
3. Pregnancy complications- PIH, placenta previa
4. Previous vertical uterine incision = never vaginal b/c risk of uterine rupture
5. Labor complications: placental abruption, uterine rupture
What are 4 fetal reasonsfor a C/S birth?
1. Fetal distress
2. prolapsed umbilical cord
3. Congential anomalies (ex. spina bifida)
4. Fetal malpresentation- breech, transverse lie, face
What are 2 maternal and fetal causes for C/S birth?
1. Dystocia, failure to progress
2. Cephalopelvic Disproportion (CPD)
What is the emotional care for patients and the families (5)?
1. They are nervous, scared, anxious
2. Often happy and exciting time as well
3. Read hx- any additional reasons for anxiety?
4. Is a repeat C/S, ask how other births have been
5. Be calm, kind, explain
What is the pre-op C/S care (10)?
1. Informed Consent; does the pt. understand why the C/S is needed?
3. Lab work = Hgb, platelets
4. IV bolus 1000cc if not contraindiated
5. Foley Catheter = to keep bladder empty
6. SCDs - sequential compression device, stays on until walking
7. Abdominal shave
8. Bicitra 30mL po neutralize stomach acids- prevent vomiting, decrease severity of aspiration pneumonia
9. prophylaxis antibiotics, preferably cefazolin IV 30-60 minutes prior
10. Emotional and family support during the C/S- ask pt. what is helpful for them
What are the 7 anatomical 'layers' in the C/S birth?
Fascia- possible adhesions if R C/S
Amnitoic Sac-fetus- pt. may feel tugging and pulling when baby is born. No pain, cut- always tell her during pre-op
What is the intra-operative care for C/S (10)?
1. Assist w/ spinal or epidural placement
2. best practice- FHR check before the incision, may omit if ER situation (external doppler)
3. Abdominal prep- betadine allergy?
4. POSITION pt. wedge under side to keep her off vena cava
5. Restrain legs- pad pressure points w/ blanket to prevent injury
6. Assess urine output/color on a timely basis, be sure the drainage bag is in view
7. Ground pt. when electrocautery is used- thigh best site
8. Oxygen mask applied
9. CRNA; monitors VS, EKG, IV
10. Surgical counts- scurb and circulator, inform MD
What are some intra-operative birth issues (5)?
1. C/S is an operation- but birth is too
2. Provide ongoing emotional support
3. Promotion of attachment
4. scheduled C/S vs. emergency C/S
5. inform mom she will feel pressure, tugging w/ birth, also lots of people in room
5. REQUIRED: formal time out
What is the immediate post-op care (7)?
1. Monitor VS (q15 min x4-5), then (q30x2) then q2hrx2 then q4x2 then q8 until d/c
2. BUBBLE HEART assessments w/ VS
3. Pulse ox, cardiac monitor, urinary output
4. possible preventive IVPB antibiotics
5. pitocin infusion
6. if PCA or duramorph- monitor for respiratory depression, effectiveness of pain relief and common s/e
7. Pt. may have transient hypothermia- bear hugger blanket
What is the post partum care (4)?
1. Monitor for infection
2. Plan for extra help at home
3. Discharge planning-recovery issues
4. Discuss w/ pt. her perceptions of the surgical birth experience
What are 6 maternal C/S risks?
1. infection 5-20 times higher for PP infection
3. Urinary tract trauma (occasionally nick bladder)
4. Paralytic ileus (stopped peristalsis, check bowel sounds)
5. anesthesia complication, aspiration
6. longer recovery time
What are two infant C/S risks
1. transient tachypnea (come out at 72-80 RR b/c they don't get the fluids out. either suctioned or absorbed)
2. laceration, bruising, trauma
What are the four advantages of a vertical skin incision?
1. quicker to perform
2. better visualization of uterus
3. easier on obese women
4. can be quickly extended for greater visualization
What are the 2 disadvantages of a vertical skin incision?
1. easily visible when healed
2. greater chance of dehiscence & hernia formation
What are the 2 advantages of a Pfannenstiel (low transverse) vertical skin incision?
1. less visible when healed
2 less dehiscense
What are the 3 disadvantages of a Pfannenstiel (low transverse) vertical skin incision?
1. cannot be done quickly
2. cannot be extended to giver greater operative exposure
3. re-entry at subsequent C/S birth may require more time
What are the 3 advantages of a vertical uterine incision?
1. may be only choice b/c of low lying placenta previa
2. dense adhesions from previous surgery
3. transverse lie of a large fetus
What are the 2 disadvantages of a vertical uterine incision?
1. more likely to rupture during subsequent birth
2. eliminated VBAC option
What are the 4 advantages of a Pfannenstiel (low transverse) vertical uterine incision?
1. unlikely to rupture during subsequent birth
2. makes VBAC possible
3. less blood loss
4. easier to repair
What is the disadvantage of a Pfannenstiel (low transverse) vertical uterine incision?
limited ability to extend laterally to enlarge incision